Pediatric Abdomen, Pediatric Urinary System

c

A midgut volvulus is diagnosed when the SMV is located on the ______ and the SMA is located on the _____ relative to patient. a) Right, right b) Right, left c) Left, right d) Left, left

midgut volvulus

A patient presents to the sonography department with bilious vomiting. While investigating the pediatric patient for pyloric stenosis, you note that while the pyloric sphincter appears normal, the SMA is abnormally located to the right of the SMV. What is the most likely diagnosis?

d

All are common clinical findings in infants who present with HPS EXCEPT: a. weight loss b. dehydration c. olive sign d. first-born female

b

All are common clinical findings in infants who present with intuss EXCEPT: a. vomiting b. first born male infant c. red currant jelly stools d. leukocytosis

a

All are sonographic findings of HPS EXCEPT: a. wall of pylorus is focally thinned b. length of pylorus measures > 17 mm c. doughnut appearance in transverse d. cervix appearance in longitudinal

a

All of the following are true of normal intestinal findings EXCEPT: a. normal bowel does not compress b. normal bowel should have observable peristalsis c. intestinal wall should measure < 5 mm d. normal bowel has little to no color on Doppler

d

Appendicitis is diagnosed when the diameter of the appendix exceeds which measurement? a) 10 mm b) 1 cm c) 5 mm d) 6 mm

renal agenesis and hypoplasia

Associated with oligohydramnios and pulmonary hypoplasia Adrenal glands well developed (2-3 cm) Urinary bladder usually absent

multilocular cystic nephroma

Benign mass with multiple thin-walled cysts or as septations within cysts. Can occur at any age

2, 6

By _____ to _____ months, pediatric kidneys have the typical echogenicity as an adult kidney.

posterior urethral valves

Caused by a mucosal flap or folds of urethral tissue obstructing the urethra Identified in utero with persistent bilateral hydronephrosis Ureters are often tortuous Bladder wall usually thickened

duplicated collecting system

Caused by ectopic insertion of ureter into UB and commonly forms a ureterocele

pyelonephritis and upper UTI

Children < 5 years with frequent UTIs should be evaluated for congenital anomalies. Most common finding is enlargement of the kidneys ** U/S is not best diagnostic imaging **

c

Clinical findings of acute appendicitis include all BUT: a. leukocytosis b. RLQ pain c. constipation d. rebound tenderness

duplicated collecting system

Diagnosed when dilation of a single pole calyx with a separate dilated ureter (NOT the whole kidney) Pathologic pole may be dysplastic or hypoplastic

prune belly syndrome

Dilation of the fetal abdomen secondary to severe bilateral hydronephrosis and fetal ascites; fetus also has oligohydramnios and pulmonary hypoplasia

16-20, obliterated

During the _____ week gestational age, the urachus narrows and should be completely _____ and fibrotic at birth

duplicated, hypo, seminal, deferens

Genital associated anomalies with renal agenesis and hypoplasia: _____ uterus and vagina _____ spadias Cryptorchidism _____ vesicle cyst Absent vas _____

c

HPS is caused by _______ of the muscular layers of the pylorus. a) Hypertrophy b) Hyperplasia c) Hypertrophy and/or hyperplasia d) Neither hypertrophy nor hyperplasia

2, 6

HPS is most often found in infants between _____ and _____ weeks of age.

angiomyolipoma

Homogenous, markedly hyperechoic benign renal cortex mass

UPJ, UVJ

Hydronephrosis: In infants, the most common site of obstruction is at the _____ (abbr) (44%). In pediatrics, the most common site of obstruction is at the _____ (abbr) (21%)

prune belly syndrome

Identified by the absence of abdominal muscles, urinary tract abnormalities, and cryptorchidism (in males). Pt. unable to contract the bladder or ureteral wall muscles. Hydronephrosis develops

Foley catheter, neurogenic, pelvic

If UB diagnosis is critical, a _____ _____ can be used to ensure bladder distention Persistent UB distention may be caused by _____ disease or _____ mass

evacuate

In infants, the urinary bladder can be difficult to visualize because warm gel and transducer pressure cause the bladder to _____

age, patient size

In pediatric kidneys, _____ and _____ _____ determine whether a linear or curved transducer is used.

RLD

In what position is an infant often placed for better sonographic visualization of the pyloric sphincter?

dysplastic kidneys

Large or small and anatomically abnormal appearing kidneys. Loss of corticomedullary differentiation Cyst development Hydronephrosis Hyperechoic cortex

ok

Locate the insertion point, tendon, muscle, cartilage and bone. Answer ok.

ok

Locate the muscle, tendon, cartilage and calcaneus. Answer ok.

rhabdomyosarcoma, homo, thickened

Malignant tumor of skeletal muscle _______________ Arises from bladder,, prostate, uterus or vagina in children Appear as a _____geneous mass adherent to a _____ bladder wall Can occupy the entire bladder Doesn't stay in one place

cystitis, 3 mm, proximal

Most common UTI in children, 10x more common in girls __________ Bladder wall usually thickened measuring > ______ in a distended UB Only a distended bladder shows bladder wall thickness _____ portion of bladder

posterior urethral valves

Most common cause of bladder outlet obstruction/urethral obstruction in the male neonate "Keyhole" sign

mesoblastic nephroma

Most common congenital abdominal neoplasm in the neonate. Benign tumor composed of connective tissue. Can replace most the renal parenchyma

multicystic dysplastic kidney

Most common cystic dysplasia of the urinary tract in pediatrics. Develops from a complete ureteral obstruction in utero. Terminal renal tubules become cysts of varying sizes that do not communicate with the collecting system.

renal, reflux

Most common indications for a _____ ultrasound. * UTI * enuresis * urgency * dysuria * urinary _____

Wilms tumor, nephroblastoma

Most common malignant renal tumor in the pediatric population. 2 names

hydronephrosis, dilation

Most common renal anomaly in infants and children. Severity is graded based on _____

mesoblastic nephroma

Most common renal tumor in newborn period <1 yo. Usually benign. Imaging appearance identical to Wilms tumor, but Wilms is usually later 3years old, not infant.

appendicitis

Name the pathology.

hypertrophic pyloric stenosis

Name the pathology.

intussusception

Name the pathology.

necrotizing enterocolitis

Name the pathology.

9, .5, 3, 7, 9

Neonate kidneys are scanned with a _____ MHz or higher linear transducer and are _____ - _____ cm deep. Pediatric patients are scanned with a _____ - _____ MHz curved OR linear transducer

prune belly syndrome

No muscles to contract UB or GB In-dwelling catheter for life to void bladder

megaureter, distal, stenosis

Nonobstructed, nonrefluxing ureter caused by idiopathic dilation Occurs as the _____ aspect of the ureter is unable to peristalse because of a _____

sinus, 10

Normal Pediatric Kidneys In childhood, half the renal pelvis is outside the renal _____, should measure less than _____ mm.

hyper, triangular, symmetric

Normal Pediatric Renal pyramids are: Slightly _____echoic _____-shaped _____ size with the pyramids evenly arranged

b

Normal neonatal renal pyramids are demonstrated sonographically as _______. a) Hyperechoic b) Hypoechoic c) Sporadically arranged d) Circular-shaped

prone, coronally

Pediatric kidneys are imaged in _____ position or _____ with patient supine.

McBurney point

Point halfway between the anterior superior iliac spine and the umbilicus; the area of pain and rebound tenderness in patients suffering from acute appendicitis

nephroblastoma

Presents as a large, well-circumscribed, homogenous mass with complex hypoechoic/cystic areas. May cause obstruction of the collecting system resulting in hydronephrosis

Wilms tumor

Presents as a palpable mass; may cause pain, fever, weight loss, hematuria, hypertension. Often invades the renal vein and IVC; allowing for infiltration to the heart and contralateral kidney

Eagle-Barrett syndrome

Prune belly syndrome AKA

RCC

Rare in children. Highly malignant. Associated with tuberous sclerosis and von Hippel-Lindau disease. Tumors are usually isoechoic or slightly hypoechoic. **abbr**

appendicitis

Rebound tenderness is associated with _____

lobulations, 1 year

Renal _____ in the cortical tissue are prominent in pediatrics and usually disappear by _____ _____ old. Those persisting into adulthood are called junctional parenchymal defects.

mesoblastic nephroma

Renal function is compromised even though neoplasm is benign Indication is resection

infection, reflux

Renal sinus wall should not be visible. If visible, chronic _____ or _____ should be suspected.

receive, <.7, blood flow

Resistive Index (RI) determines the ability of a system to _____ blood flow. Interlobar/arcuate arteries should demonstrate a RI _____ If RI is above that number, it indicates the area is not receiving proper _____ _____

renal, vascular

Resistive index is used to diagnose _____ disease and _____ disease.

renal hypoplasia

Small, normal appearing kidneys resulting from atrophy secondary to infection or vascular occlusion

obstruction

Sonographic finding of fluid-filled, distended loops of bowel is consistent with intestinal _____

intuss

Telescoping of one segment of bowel into another is _____ (abbr)

palpable pyloric sphincter

The "olive" sign is best described as an enlarged ____ _____ _____

renal vein, color

The _____ _____ can be mistaken for hydronephrosis. Not sure? Put _____ on it.

a

The aorta is _______ to the left adrenal gland. a) Medial b) Lateral

echo

The cortical tissues in neonates and infants is normally more _____genic than in adults

intuss

The most common cause of intestinal obstruction in children less than 2 years is _____ (abbr)

cecum

The most common location of the vermiform appendix is in the area of the _____

perirenal, superficial, perirenal

The neonate adrenals are proportionally larger than adult glands. Newborn infants' sparse _____ fat allows for better imaging. More _____ than adult adrenals. Located in the_____ space.

a

The normal neonatal adrenal gland medulla (Oreo cookie) is _______. a) Hyperechoic b) Hypoechoic c) Isoechoic

a

The normal resistive index in any peripheral renal artery should be _______. a) <0.70 b) >0.70 c) >1.00 d) <1.00

b

The renal cortex of a normal 2-day old kidney is _______ compared to the normal newborn liver. a) Isoechoic b) Echogenic c) Anechoic d) Hypoechoic

d

The stomach is predominately located in which one of the following regions? a) Umbilical b) Right hypochondriac c) Left hypochondriac d) Epigastric

anterior, umbilicus

The urachus is a tubular structure continuous with the _____ bladder dome extending through the peritoneum to the _____

enema

Traditionally, treatment for intuss is by means of therapeutic _____

appendicolith, fecalith

Upon sonographic evaluation of the RLQ in a patient complaining of focal abdominal pain in that area, you visualize a hyperemic blind-ended, tubular structure that contains shadowing focus. What is the most likely etiology of the shadowing? 2 names

intuss

What abnormality associates with red currant jelly stools? (abbr)

a

What dense fibrous structure connects a bone to a muscle? a) Tendon b) Nerve c) Ligament d) Muscle

c

What is the definitive sonographic characteristic of NEC? a) Ascites accumulation in the abdomen/pelvis b) Bilious emesis c) Air within the intestinal walls d) Distention of the stomach and/or duodenum

a

What is the most common adrenal tumor? a) Neuroblastoma b) Pheochromocytoma c) Nephroblastoma d) Rhabdomyosarcoma

a

What is the most common cause of ureteral obstruction in pediatric males? a) Posterior urethral valves b) Urolithiasis in the urethra c) Nephrolithiasis d) Mesoblastic nephroma

c

What is the most common congenital abdominal neoplasm in the neonate? a) Renal cell carcinoma b) Pyelonephritis c) Mesoblastic nephroma c) Nephroblastoma

b

What is the most common cystic dysplasia of the urinary tract in pediatrics? a) Eagle-Barrett syndrome b) Multicystic dysplastic kidneys c) Nephroblastoma d) Wilms tumor

a

What is the most common malignant renal tumor in pediatrics? a) Nephroblastoma b) Neuroblastoma c) Renal cell carcinoma d) Angiomyolipoma

d

What scan plane terminology should be used when evaluating the maximum width of a ligament or tendon? a) Sagittal b) Transverse c) Long axis d) Short axis

c

What structure connects one bone to another bone and provides strength and stability? a) Nerve b) Bursa c) Ligament d) Tendon

d

What structure is considered a continuation of a tendon and provides the ability of movement. a) Ligament b) Nerve c) Tendon d) Muscle

peak, end

When measuring RI, the _____ of arterial waveform to the _____ diastolic is measured.

patent

When the urachus fails to close and becomes fluid-filled a _____ urachus can be diagnosed with ultrasound

b

Where is the most common location of a ureter obstruction in infants causing hydronephrosis? a) PUV b) UPJ c) UVJ d) Minor calyx

b

Which on the following neoplasms presents as a hyperechoic benign renal mass in the cortex? a) Wilms tumor b) Angiomyolipoma c) Rhabdomyosarcoma d) RCC

b

Which one of the following complications of intussusception has the worst prognosis? a) Ischemia b) Perforation c) Necrosis d) Lethargy

d

Which one of the following is NOT associated with prune belly syndrome? a) Absent abdominal muscles b) Cryptorchidism c) Hydronephrosis d) Hirsutism

a

Which one of the following stomach structures is located the most distal? a) Pyloric sphincter b) Fundus c) Body d) Pyloric antrum

b

Which synovial fluid measurement would be considered normal if we are evaluating a bursa? a) 0 mm b) 2 mm c) 4 mm d) 6 mm

c

Which type of intussusception usually requires intervention? a) Jejunoileal b) Jejunojejunal c) Ileocolic d) Ileoileal